Neuroepidemiology最新文献

Introduction: Stroke is a leading cause of morbidity and mortality, particularly in older adults. Identifying lifestyle factors, such as physical activity (PA), that mitigate stroke risk is critical for stroke prevention, especially in postmenopausal women. We sought to determine the association between levels and types of recreational PA and risk of total, ischemic, and hemorrhagic stroke in postmenopausal women.

Methods: We performed a prospective cohort study conducted within the Women's Health Initiative from 1993 to 1998 with a mean follow-up of 8.5 years. We studied a total of 139,871 postmenopausal women aged 50-79 years without prior cardiovascular disease or stroke at enrollment. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Recreational PA was assessed via questionnaire, including total, light, moderate, and vigorous activities and walking. Incident total, ischemic, and hemorrhagic strokes were recored. HRs and 95% CIs were adjusted for sociodemographic, lifestyle, and clinical factors.

Results: During follow-up, 4,642 stroke occurred (3,496 ischemic and 728 hemorrhagic). Higher levels of total PA (per 1 SD MET-hr/wk: HR = 0.90, 95% CI: 0.87-0.93), walking (HR = 0.93, 95% CI: 0.90-0.96), and moderate PA (HR = 0.91, 95% CI: 0.88-0.94) were associated with reduced total stroke risk. Similar inverse associations were found for ischemic stroke. Vigorous PA demonstrated a J-shaped association with ischemic stroke, while light PA was not significantly associated with stroke risk. Total (HR = 0.90, 95% CI: 0.83-0.97) and vigorous PA (HR = 0.88, 95% CI: 0.81-0.96) were inversely associated with hemorrhagic stroke. Associations were consistent across subgroups defined by age, race/ethnicity, blood pressure, hormone therapy use, BMI, and dietary intake.

Conclusion: Increased recreational PA, particularly moderate, with cautious interpretation of vigorous activity due to its J-shaped association and potential risks, is associated with reduced risks of total and ischemic stroke in postmenopausal women. Our findings support promoting PA as a key strategy for stroke prevention in this population.

Introduction: Evaluating long-term trends for the incidence of intracerebral hemorrhage is a priority for primary prevention. It is also important to assess the trends in the proportions of bleeding sites because the pathogenesis, prognosis, and operative procedures differ among them.

Methods: A prospective community-wide stroke registry in two rural Japanese communities (Ikawa Town and Kyowa Town, with populations of approximately 5,000 and 15,000, respectively) was conducted. The age-adjusted incidence of intracerebral hemorrhage from 1985 to 2017 was calculated by the direct method using the World Standard Population. The proportions of intracerebral hemorrhage by bleeding sites (putamen, thalamus, lobes, cerebellum, and brain stem) based on neuroimaging were calculated in each of the following three periods: 1985-1995, 1996-2006, and 2007-2017.

Results: During the study period, 383 intracerebral hemorrhage events as first-ever strokes were registered. The age-adjusted incidence declined over time by 33%, with a large reduction between 1985-1989 and 1990-1994, but the magnitude of the decline has diminished since the 1990s. The proportions of bleeding sites were 37%, 29%, and 31% for the putamen in 1985-1995, 1996-2006, and 2007-2017, respectively; the corresponding proportions were 24%, 35%, and 18% for the thalamus; 10%, 10%, and 21% for lobes; 2%, 8%, and 12% for the cerebellum; and 8%, 6%, and 5% for the brain stem.

Conclusion: The age-adjusted incidence declined by 33% from the 1990s, with a large reduction in the early 1990s in Japanese rural communities. Among intracerebral hemorrhages, the proportion of bleeding sites decreased for the putamen, thalamus, and brain stem and increased for lobes and the cerebellum.

Introduction: Moyamoya angiopathy (MMA) has been reported in the ethnically diverse Auckland region of New Zealand, but the sociodemographic burden and clinical outcomes remain poorly characterised. This study aimed to determine age, sex, and prevalence of MMA stratified by ethnicity and assess clinical outcomes in adults residing in Auckland (population 1.9 million).

Methods: A retrospective review of patient records and radiology reports from 2008 to 2025 was conducted using ICD codes and keyword searches. Prevalence was estimated using national census data. Primary outcomes were functional independence (modified Rankin Score 0-2) and the composite of stroke or transient ischaemic attack. Associations were assessed using univariate and multivariate Cox regression. A pooled analysis of published cohorts was also performed for context.

Results: A total of 100 patients were identified (73% female; mean age 38.5 years, SD 17). Period prevalence was highest among Pacific peoples (11/100,000), followed by Māori (6/100,000), Asians (4/100,000), and Europeans (2/100,000). Overall prevalence increased from 0.8 to 4.5 per 100,000 between 2001 and 2025 (p ≤ 0.0001). During a median follow-up of 4.2 years, 39% experienced a cerebrovascular event, at a median of 647 days from diagnosis. Two-thirds remained functionally independent. Bilateral internal carotid artery involvement (hazard ratio [HR] 0.52, 95% confidence interval [CI]: 0.30-0.91) and recurrent cerebrovascular events (HR 0.54, 95% CI: 0.31-0.94) were associated with a reduced likelihood of functional independence, while antithrombotic use was protective (HR 2.1, 95% CI: 1.11-3.9). Functional outcomes were consistent with other international cohorts.

Conclusion: This population-based study highlights marked ethnic variation in MMA prevalence, with the highest rates in Pacific peoples, and an elevated risk of early cerebrovascular events. These findings have implications for timely diagnosis and targeted management in diverse populations.

Introduction: Conflicting findings exist between weight change and ischemic stroke risk. Studying the association between body weight change and ischemic stroke risk helps clarify the true nature of the association and supports future health promotion and stroke prevention strategies.

Methods: We longitudinally assessed data from 10,985 ARIC visit 4 participants (1996-1998). After excluding individuals with missing data on previous stroke or coronary heart disease at baseline (visit 4), we classified 9-year weight change (visit 4 minus visit 1 weight) into quintiles of weight change and weight loss (>-2.7 kg), no change (-2.7 to +2.7 kg), and weight gain (>+2.7 kg) categories. We used crude and adjusted Cox regression models to assess ischemic stroke hazard. We also performed an analysis stratified by body mass index (BMI) status to see if the weight change-stroke risk relationship differed by baseline BMI.

Results: Among 9,574 participants, 676 developed ischemic stroke during the 20-year follow-up. Most participants at baseline were female (58.25%) and drinkers (50.52%), with mean age of 62 and mean BMI of 28.78 kg/m2. Compared to participants with no change, those who gained weight had 23% lower hazards of ischemic stroke (hazard ratio [HR] = 0.77 (95% confidence interval [CI] = 0.60, 0.99)), while those who lost weight had 30% higher hazards (HR = 1.30 [95% CI = 1.05, 1.62]).

Conclusion: Weight change showed minimal association with stroke risk overall, with moderate weight gain potentially lowering the risk, while weight loss increased it. These results emphasize the intricate relationship between weight dynamics and cerebrovascular health and the potential complex implications of the degree and direction of weight change for stroke prevention.

Introduction: The relationship between herpes simplex virus (HSV) infection and the risk of Alzheimer's disease (AD) remains unclear.

Methods: A systematic review and meta-analysis were conducted to investigate this potential association. Observational studies were sourced from PubMed, Embase, Web of Science, and the Cochrane Library up to July 31, 2024. The analysis utilized the generic inverse variance method with a random-effects model. Effect sizes were calculated as odds ratios (ORs) or hazard ratios (HRs) with corresponding 95% confidence intervals.

Results: A total of 26 original studies, encompassing 1,213,193 participants, were included in the meta-analysis. The findings indicated a 32% higher likelihood of AD in individuals with HSV infection in case-control studies (OR = 1.32; 95% CI: 1.12, 1.55; I2 = 22.7%) and a 20% increased risk in cohort studies (HR = 1.20; 95% CI: 1.10, 1.31; I2 = 11.0%). Specifically, HSV-1 infection was associated with 46% higher odds of AD (OR = 1.46; 95% CI: 1.14, 1.86; I2 = 3.1%).

Conclusion: This meta-analysis demonstrates an association between HSV infection and increased risk of AD, particularly for HSV-1. Given the high global prevalence of HSV-1 and the heterogeneity of existing evidence, these findings should be regarded as hypothesis-generating, underscoring the need for rigorous, biomarker-informed studies to clarify causality, and identify susceptible subgroups.

Introduction: The aim of this study was to characterize the epidemiology, risk factors, and clinical presentation of Wernicke encephalopathy (WE) and analyze differences between cases with and without excessive alcohol consumption.

Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science up to April 1, 2025. The included studies provided data on prevalence, risk factors, clinical and radiological findings, mortality, and prognosis in patients with WE. Pooled proportions and weighted means were calculated using random-effect models with Freeman-Tukey transformation. Heterogeneity was assessed using the I2 statistic. Subgroup comparisons were performed based on the presence or absence of excessive alcohol consumption.

Results: A total of 12 studies comprising 5,510 patients were analyzed. Overall, 65.4% (95% CI: 56.0-74.2) were male, with a weighted mean age of 60.7 years. Among cases related to excessive alcohol consumption, 78.7% were male (mean age 55.2); in cases not related to such consumption, 52.6% were male (mean age 63.5). The classic triad was present in 32.7% of cases (95% CI: 19.2-47.7). Among patients evaluated by magnetic resonance imaging, typical lesions were identified in 82.0%, and atypical lesions were identified in 44.8%. Overall mortality was 5.1% (95% CI: 2.3-8.8%) and higher in non-alcohol-related cases (8.8%). Alcohol consumption was the main risk factor (90.7%); among non-alcohol-related cases, the most frequent clinical settings were malnutrition (30.2%), infections (25.1%), and psychiatric disorders (15.4%).

Conclusion: WE is a multifactorial syndrome that extends beyond alcohol misuse, with wide clinical and pathophysiological variability. These findings underscore the importance of early recognition and prompt thiamine replacement, particularly in non-alcohol-related cases.

Introduction: The pace of cognitive change is one of the major questions in cognitive aging. The Children of the Depression Age (CODA) cohort of the Health and Retirement Study (HRS) is uniquely suited to study cognitive aging because it has a long follow-up (22 years) and a narrow age range at baseline (67-74 years) and presents a unique opportunity to study this topic.

Methods: We examined delayed recall data over the 22 years of follow-up in a nationally representative sample of the USA (HRS-CODA; N = 2,295 at baseline and N = 263 at the final follow-up wave), examining results for the entire sample and omitting participants with self-reported dementia. Data were analyzed using latent growth curve models, adjusting for baseline age, sex, years of education, and race/ethnicity.

Results: Respondents were predominantly female (62%), white (86%), and 71 years old on average at baseline. Our results suggest the pace of normative (defined as the absence of a dementia diagnosis over the follow-up period) memory decline is about -0.05 standard deviations per year (SD/y) but is better characterized by age-specific estimates of -0.04 SD/y, -0.10 SD/y, and -0.15 SD/y for an individual who was 75, 85, and 95, respectively.

Discussion: Memory decline, in the absence of a recognized dementia and without a confounding of baseline age differences and longitudinal age changes, would be present but almost imperceptible to an individual in their eighth decade, but noticeable in their ninth and quite impairing in their tenth decade. Future research is needed to examine other cognitive domains and with more robust measures.

Introduction: Myasthenia gravis (MG) presents a substantial clinical burden, characterized by increased incidence of myasthenic crises, heterogeneity in treatment response, significant functional impairment, and gradually increasing mortality rates with marked geographical heterogeneity across China. While improving quality of life (QOL) is the focus of MG management, multifactorial determinants of QOL impairment remain unclear, especially in socioeconomically underrepresented regions, particularly Southwestern China. This study aimed to explore myasthenia-specific risk factors for QOL and develop a parsimonious prediction model.

Methods: This study performed univariate and multivariate regression analyses on 310 MG patients diagnosed at the First Affiliated Hospital of Chongqing Medical University between January 2022 and February 2025 from Southwestern China. The QOL of patients was evaluated with the 15-item Myasthenia Gravis Quality of Life (MG-QOL15). Disease severity was evaluated with current Myasthenia Gravis Foundation of America (MGFA) classification, MG-related activity of daily living (MG-ADL) score and quantitative myasthenia gravis (QMG) score. Relevant clinical and demographic data were included in the analysis.

Results: In the analysis of basic characteristics, higher ADL (p < 0.001), worse MGFA classification (p < 0.001), lower education level (p = 0.006), thymic abnormalities (p = 0.004), and treatment (p = 0.003) were significantly correlated with poor QOL. However, factors such as age of onset, gender, and antibody status showed no significant impact. The multivariate models (Model 1-6) further confirmed that MG-ADL (OR = 8.397), QMG score (OR = 4.357), MGFA classification, and thymus histology (thymic hyperplasia OR = 4.505, thymoma OR = 2.472) were independent risk factors for QOL. Corticosteroids combined with immunotherapy were found to significantly improve QOL compared to monotherapy. Model validation indicated that Model 5, which incorporates MG-ADL, MGFA classification, thymus histology, and education level, had the optimal overall performance (area under the curve = 0.835, specificity 0.917), balancing predictive accuracy and clinical applicability.

Conclusion: By identifying key predictors, including clinical severity, thymic abnormalities, and education level, this study developed a multidimensional prediction model for QOL in MG patients.

Introduction: Early medical complications following acute ischemic stroke (AIS) are common and might increase poststroke morbidity and mortality. This study aimed to evaluate trends in the prevalence of early medical complications over almost 2 decades and their impact on 3-month functional outcome and mortality.

Methods: A total of 181,704 AIS patients from the Austrian Stroke Unit Registry (2006-2024) were analyzed. Early medical complications included decompensated heart failure, cardiac arrhythmia, sepsis, pneumonia, urinary tract infection (UTI), deep vein thrombosis, and pulmonary embolism. Functional outcomes were assessed using the modified Rankin Scale (mRS) after 3 months, with favorable outcome defined as mRS ≤1. Associations between early medical complications and mRS were analyzed using multivariable Poisson regression models.

Results: Among all patients, 16,279 (9.0%) had early medical complications. Pneumonia (4.2%), UTI (2.9%), cardiac arrhythmia (1.4%), and decompensated heart failure (1.4%) were most common, with significant declines in prevalence over time. Admission NIHSS scores decreased, and the use of intravenous thrombolysis and mechanical thrombectomy increased. Decompensated heart failure (RR = 1.85, 95% CI: 1.73-1.97, p < 0.001), sepsis (RR = 1.75, 95% CI: 1.53-1.99, p < 0.001), pulmonary embolism (RR = 1.67, 95% CI: 1.33-2.10, p < 0.001), and pneumonia (RR = 1.64, 95% CI: 1.57-1.72, p < 0.001) were significantly associated with 3-month mortality. Furthermore, the complications least associated with a favorable outcome were pneumonia (RR = 0.36, 95% CI: 0.32-0.41, p < 0.001), decompensated heart failure (RR = 0.38, 95% CI: 0.32-0.46, p < 0.001), and sepsis (RR = 0.59, 95% CI: 0.45-0.77, p < 0.001). The effect sizes did not change significantly through the observed years.

Conclusions: This study observed a significant reduction in the prevalence of early medical complications after AIS, especially decompensated heart failure, pneumonia, sepsis, and pulmonary embolism which continue to substantially affect mortality and functional outcome in AIS patients.